IVF treatment add-ons: An in-depth series

Welcome to our series where we explore all the different IVF add-ons and treatments.

When we were going through our IVF journey we weren’t really all that clued up on IVF and the many options that you could have.

During the process, from the many wonderful people we have met, who are also on their own personal IVF and assisted reproduction journeys and from the 100’s of hours of research we have done since starting this website we realised something….

How is anyone supposed to make informed consent on their IVF treatment if honest accurate information isn’t being presented to them.

Before we get started, if you haven’t already watched the BBC Panorama undercover documentary on IVF add-on treatments it makes for a fascinating watch, it’s only 30 minutes long. But it highlights the importance of self-learning when you embark on your IVF journey, which is linked below.

An interesting watch…

Right!

Why are some IVF clinics not giving patients all the information about IVF treatment add-ons?

The scary thing is, is that this is common practice across the private IVF sector. The IVF market is huge and growing bigger. The global IVF market is worth $16.68 billion in 2018 and is growing by 9.8% per year. In the UK the IVF market is worth £320 million which is expected to grow to £723 million by 2026.

This is a very strong driver for commercial gain.

The majority of private IVF clinics are wanting to help people, but there are certainly some who play on emotions.

What do I mean by this?

Infertility is an incredibly personal and emotional time. The desire to have children experienced by men and women alike are incredibly strong drivers of action. Couple this with the known fact that fertility is an ever-decreasing issue as women age.

This means that it is an area primed for strong emotional selling and gives clinics the opportunity to take advantage of these feelings and couples situations.

How much do you REALLY want a baby?

The title isn’t meant to offend or make you actually question that. We know that if you have been trying for a sustained period of time, been through fertility testing and reached the point of needing IVF then that desire can’t be any higher!

However, when you look at the price lists, the catalogues and websites of private IVF clinics I can’t help but sometimes think they read like a menu titled

“How much do you want a baby?”

With Premium options and exciting wording designed to make you believe you are giving yourself the best chance at getting what your heart desires most… a child.

You might be presented with a beautiful looking menu like the one below taken from a UK Private Clinic

Then if you delve into the treatment options you’re often met with positive information about how it will improve your chances at having a baby, with links from tiny studies showing substantial increases in success rates (often these studies are even done by the clinics themselves), then a tiny link the HFEA Website and if your lucky it might say that this treatment is unproven.

It’s not really good practice and it isn’t right.

So, what can be done about it?

Why don’t the HFEA do something?

You would think that the body who give clinics their licencing would be able to tightly regulate the industry. But no! If like me you thought

“Medications have to go through large scale random controlled trials to become approved, look at effectiveness and monitor side effects so must IVF treatments”

Then you’d be wrong!

There is no requirement for these treatments to be based in evidence to be offered to couples, there is a requirement for them to give you all the facts, although as you have seen this doesn’t always occur,

The HFEA have stated that they are very concerned about the selling of IVF treatment add-ons however, they don’t have the power or regulatory authority to stop these being sold or have any power to control pricing. However, if you experience mis-selling we advise you to report the clinic to them.

Great!

So, the authorising agency involved in IVF can’t do diddly squat about poor practices around selling untested and non-evidenced procedures for couples desperate to get pregnant.

Don’t get me wrong, the HFEA have done an amazing job at improving laboratory processes, reducing multiples and tracking clinic rates. But in this area, they haven’t done enough, it’s not their fault but the government need to extend the powers to encompass these areas to ensure a fair operating market for all, which doesn’t allow people to be taken advantage of during this emotionally vulnerable time.

 

Which leads us to ask,

“what can be done about it?”

Why have we started this series?

Well unfortunately until the regulatory bodies get more powers then this practice will never stop. The HFEA have gone some way to trying to alleviate this through creation of a website which talks about these which you can find here.

We feel that still gives you a very top-level view of the treatment, each treatment has about 150 words a traffic light warning and little else.

Hence, we wanted to pull together educational resources on each one of the main IVF treatment add-ons and present them to you. Exploring what the treatments are, what is the theory behind why they should work, what the latest research shows, how much they cost, what are the additional risks and if we would recommend them based on this information.

What are the IVF Treatment Add-on’s

This article is meant to serve as a central point of access to all the information about these additional IVF treatments. You can click on the image or the title to take you to main article about each of these options and at the bottom we have created a simple table with all the options on there and our rankings

Elective Freeze All Cycles

These are incredibly common in the US and becoming more common in the UK. It is an IVF cycle which stops after egg retrieval and then freezes the eggs or embryos for frozen transfers later. It is an option to have eggs because as we get older we become less fertile. It can give people the peace of mind that when they meet the right person or want children no matter the age they still have that option.

Assisted Hatching

Assisted Hatching is an additional treatment which takes place in the lab, there are many techniques which can be used the most common of which is laser assisted hatching. They use these techniques to either make a hole or thin the Zona (membrane around the blastocyst) to help it to hatch and in theory improve chances of implantation

Embryo Glue

Embryo glue is an option which means they place your embryo into a substance known as HA (Hyaluronic Acid) before implantation. This is a naturally occurring compound which in theory helps the embryo implant.

Reproductive immunology

This is a catchall term which is used by a small number of doctors who feel that the immune system is a large part of the reason that the embryo doesn’t take because our own bodies attack it. It is a very expensive option that does test for many types of immune cells and responses such as natural killer cells. Using these it then designs a treatment using immunosuppressants, steroids and other medications before and after IVF. This has substantial risks.

Time-Lapse Imaging

This is another lab-based technique. The embryologists have a special camera which takes images of the embryonic development at regular intervals. These images are used to track the specific timing of certain stages of development. These images are then turned into ‘maps’ a series of images which are fed through an algorithm which then gives an embryo quality grading and or a percentage chance of pregnancy.

IMSI

This is an advancement on ICSI where they use super high magnification to look at the sperm in more detail before selection. It allows the embryologist to look specifically at the morphology of the sperm, with a specific focus on the head. In theory this allows them to identify deformities that wouldn’t be seen under normal magnification.

PICSI

This is another advancement on ICSI. In this one they place the sperm in Hyaluronic Acid (HA). They wait for the sperm to bind to the HA then select one of these. In theory using sperm that are able to bind to HA means there should be a lower risk of fragmented DNA and chromosomal irregularities resulting in a greater chance of fertilisation and continued pregnancy.

Endometrial Scratch

This is a procedure that is performed before collection. A small cut is made in the endometrial lining, which is thought to trigger an immune response which leads to a greater chance of implantation. It is done as a day procedure and causes a little discomfort and only takes about 15 minutes.

Preimplantation genetic screening

This is a lab-based treatment, where they screen the embryo for chromosomal deficiencies which would likely be incompatible with life. Meaning that they can select embryo’s which are known to have less chance of defects and therefore the most chance of implantation and live birth. This is a very expensive option. It can be had on the NHS if you have a specific hereditary disease which means it’s prudent to test.

Our Overall Ratings for IVF Treatment add-ons

I hope you have looked through the guide above to get a solid understanding of some of the key options available to you. Using the information found within these guides these are our ratings, it’s important to note that these ratings are our own opinion from the extensive research we have done. Some of these treatments may be suggested to you due to a very specific situation or condition e.g. PGS for a Huntington’s or other rare genetic disorders should be led by your specialist. These are for people with no specific conditions where these treatments are completely optional. We will put some of the key caveats into the last column.

Treatment HFEA rating Cost Evidence Risks Our final rating Caveats
Embro Glue Amber moderate moderate Low Recommend for peace of mind None
Assisted Hatching Red moderate Very poor Moderate to low Do not recommend None
Reproductive immunology Red Very high Poor Very high Do not recommend If you have a specific autoimmune illness, which you know you may need specific treatment whilst trying to conceive. This treatment shouldn’t be new at IVF stage if it is it’s unlikely to qualify as a caveat
Elective Freeze All Cycles Amber Very High Moderate to good moderate Recommend We recommend this specifically to people who feel it’s the right choice for them. There is nothing that would discourage us from recommending this option if you think it’s right for you.
IMSI Red Low Very Low Low Do not recommend  
PICSI Red Low Very Low Low Do not recommend Possible peace of mind option after multiple failed IVF cycles/miscarriages
Time Lapse imaging Amber Moderate Moderate Very low Recommend for peace of mind  
Pre-implantation genetic screening

Red 3-day testing

Amber 5-day testing

Very High Moderate Moderate Do not recommend

I feel this is only necessary in cases where a clear genetic problem is known and screening is advisable.

In the USA this is a common treatment for those with multiple failed implantations, however from the evidence I don’t feel it’s strong enough against the cost to offer good value for money to all but the most extreme cases.

Endometrial Scratch Amber Low to moderate moderate moderate Recommend at this price point after failed attempts. There is new research about to be released, we will update this upon the results being made public

We hope you have found this series useful and that you feel more able to make informed consent about the IVF treatment options which are right for you.

If you want us to cover a specific add-on that we haven’t already then please leave a comment and we’ll look into adding it.

2 Comments

  1. There are various add-on therapy like immunotherapy, endometrial receptivity array, endometrial scratching, uterine artery vasodilation, and intrauterine HCG all these expensive treatments are not full proof and do not have a proof that it will get you pregnant.

    Reply
    • Very true, much of the evidence associated with IVF add-ons is moderate at best. In fact most of it is of poor quality or involve heavily biased studies. It’s important for patients to advocate for themselves and get a solid understanding of the treatments that they are being recommended before they sign up for a treatment plan. Also we think more needs to be done to regulate the emotional selling of IVF add-on treatments through stronger regulatory frameworks or including this within the auditing framework of the regulatory bodies, namely the HFEA in the UK.

      Reply

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